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Autism and reactive attachment/disinhibited social engagement disorders: Co-occurrence and differentiation.

Authors
  • Mayes, Susan Dickerson1
  • Calhoun, Susan L1
  • Waschbusch, Daniel A1
  • Baweja, Raman1
  • 1 Department of Psychiatry (H073), Penn State College of Medicine, Penn State Health Milton S. Hershey Medical Center, USA.
Type
Published Article
Journal
Clinical child psychology and psychiatry
Publication Date
Oct 01, 2017
Volume
22
Issue
4
Pages
620–631
Identifiers
DOI: 10.1177/1359104516678039
PMID: 27895198
Source
Medline
Keywords
License
Unknown

Abstract

DSM-5 ( Diagnostic and Statistical Manual of Mental Disorders, 5th edition) Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED) are rare disorders sharing social difficulties with autism. The DSM-5 and ICD-10 (International Classification of Diseases, 10th revsion) state that RAD/DSED should not be diagnosed in children with autism. The purpose of our study is to determine whether children can meet criteria for both autism and RAD/DSED and to identify specific symptoms discriminating the disorders. Subjects were 486 children with autism and no RAD/DSED and 20 with RAD/DSED, 4-17 years of age. In total, 13 children with RAD/DSED met criteria for autism. Using the Checklist for Autism Spectrum Disorder (CASD), there was no overlap in total scores between the RAD/DSED with autism group (score range = 15-27) versus the RAD/DSED without autism group (range = 7-10 ). The autism with and without RAD/DSED groups did not differ in CASD scores. Nine of the CASD autism symptoms were found only in the autism with and without RAD/DSED groups. Our study demonstrates that children can meet criteria for both autism and RAD/DSED and that the disorders are easily differentiated by the presence of specific autism symptoms. Autism is a neurogenetic disorder, and RAD/DSED results from severe social-emotional maltreatment. Given the different etiologies, there is no reason why a child cannot have both disorders.

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